How cause of injury is determined in a workers’ compensation case.
One of the main issues in a workers’ compensation case is determining the cause of one’s injuries. From a legal perspective, determining the cause and type of causal relationship is an important element of a workers’ comp case since it gives insight into who is responsible for the accident and injuries of an injured worker.
However, interpretations of cause and related definitions are often confusing, since the legal definitions, interpretations and standards for causation in workers’ compensation judgement vary from jurisdiction to jurisdiction.
Direct causation refers to situations where the injury or inherent factors of employment result in the condition claimed, through an organic and unbroken sequence.
For example, if an injured worker suffers a laceration to the body in an accident, the accident would be the direct cause of the laceration.
If a pre-existing condition is worsened, either temporarily or permanently, by a work-related injury or other accident, that condition is said to be aggravated. Therefore, an aggravation of a pre-existing condition must include an accident that worsens the circumstances of a susceptible condition.
Temporary aggravation implies that the aggravation is temporary or self-limited, causing only a brief increase in symptoms, without persistent effect. This is sometimes referred to as an “exacerbation” and usually involves a limited period of impairment and/or medical treatment, after which the worker returns to his or her previous medical status.
Permanent aggravation occurs when an injury causes permanent, long-lasting changes in the natural course of an ongoing condition. A permanent aggravation alters the natural course of the pre-existing condition, accelerating or worsening that condition, such that it will never return to the pre-injury state.
THE BENEFIT OF A WORKERS’ COMPENSATION LAWYER
Identifying the cause and causal relationship of pain after suffering an injury on the job can complicate a workers’ comp claim, especially if a previously undiagnosed pre-existing condition exists. For example, an employee is hurt in a slip-and-fall while on the clock. They experience persistent lower back pain that causes them to have mobility issues. Prior to the accident, this employee had not felt pain in their back, and had no previous surgeries or complications relating to the spine, lower back or mobility.
A physician examines the employee and orders an MRI of their spine, which reveals arthritis, a degenerative bone disease that has been asymptomatic and previously undiagnosed. The doctor concludes the arthritis could not and was not caused by any single event or accident, including the employee’s most recent work accident. Following the physician’s assessment, the employee is denied treatment through workers’ compensation.
In a case like this, the injured worker would be best assisted by an experienced workers’ compensation attorney. Although arthritis is a painful bone condition, a workers’ compensation attorney could argue that the employee did not present symptoms of back pain attributable to arthritis prior to their accident, only suffering pain following their injury. Therefore, it can be reasonably concluded the cause of the present back pain can be traced back to the work accident. Under this theory, the injured worker would be eligible to receive treatment under workers’ compensation regardless of their pre-existing arthritis because the work accident caused the symptoms that didn’t exist prior to the accident.